Healthcare Provider Details

I. General information

NPI: 1043174253
Provider Name (Legal Business Name): RIDEWAY TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 AVENIDA DEL CLB
CLEWISTON FL
33440-8368
US

IV. Provider business mailing address

215 AVENIDA DEL CLB
CLEWISTON FL
33440-8368
US

V. Phone/Fax

Practice location:
  • Phone: 786-521-0748
  • Fax: 863-301-0051
Mailing address:
  • Phone: 786-521-0748
  • Fax: 863-301-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: RIDOSBEL DE LA ROSA
Title or Position: OWNER
Credential:
Phone: 786-521-0748